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- $94.99Save $20Comp. Value: $114.99Digital delivery
- $59.99Save $20Comp. Value: $79.99Digital delivery
- $109.99Save $20Comp. Value: $129.99Digital delivery
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H&R Block - Tax Software Deluxe + State 2025 PC/Mac [Key Card] - Windows
Publisher: H&R Block$49.99Get it by Fri, Feb 20 • FREE
- $174.99Save $15Comp. Value: $189.99Digital delivery
- $49.00Save $30Comp. Value: $79.00Digital delivery
- $14.47
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- $14.53
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- $11.38
Get it by Wed, Feb 18 • FREE
- $51.89
Get it by Tue, Feb 17 • FREE
- $29.99
Get it by Wed, Feb 18 • FREE
- $13.45Save $1.37Comp. Value: $14.82
Get it by Wed, Feb 18 • FREE
- $12.59
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- $34.59
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- $8.66
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- $10.91
Get it by Tue, Feb 17 • FREE
![HEALTH INSURANCE CLAIM FORM
[Form Number]
[Insurer's Name and Logo]
[Insurer's Address]
[Insurer's Contact Information]
[Policyholder's Name]
[Policyholder's Address]
[Policyholder's Contact Information]
[Policy Number]
[Claim Number]
[Date of Claim]
[Date of Service]
[Type of Service]
[Service Provider's Name]
[Service Provider's Address]
[Service Provider's Contact Information]
[Service Description]
[Service Date]
[Service Amount]
[Service Amount Paid by Insurer]
[Service Amount Paid by Policyholder]
[Service Amount Not Covered]
[Total Claim Amount]
[Signature of Policyholder]
[Signature of Service Provider]
[Date]
[Insurer's Approval Signature]
[Date]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]
[Insurer's Address]
[Insurer's Contact Information]](https://pisces.bbystatic.com/image2/BestBuy_US/images/products/e4070712-abbf-43af-8b6b-679520e671c1.jpg;maxHeight=427;maxWidth=640?format=webp)
![Sure, here is the corrected and grouped text from the image:
**AAP - PURCHASE ORDER**
**ITEM**
1. **A DAY**
- 2nd GAY
- 3rd CalY
- DAY AVO
- 1 e 1 E
- E D C I t
- E a 5 1 E
- . . 8 F 8 DAY
- DA . g . t 1 e 1 E
2. **A DAY**
- NOT TO DESCRIBE
3. **A DAY**
- VICK
4. **A DAY**
- NOT ACT
5. **A DAY**
- NOT DESCRIBE
6. **A DAY**
- NOT THE DATE
7. **A DAY**
- NOT THE DATE
8. **A DAY**
- NOT THE DATE
9. **A DAY**
- NOT THE DATE
**RECEIVED BY**
- [Signature]
- [Date]
**SIGNATURE**
- [Signature]
- [Date]](https://pisces.bbystatic.com/image2/BestBuy_US/images/products/07bf4bb9-f19c-4c6a-b2b6-c2deaf209881.jpg;maxHeight=427;maxWidth=640?format=webp)
![Purchase Order
123456
[Vendor Information]
[Vendor Name]
[Vendor Address]
[Vendor Phone]
[Vendor Email]
[Buyer Information]
[Buyer Name]
[Buyer Department]
[Buyer Phone]
[Buyer Email]
[Date]
[Order Date]
[Delivery Date]
[Item Description]
[Quantity]
[Unit Price]
[Total Price]
[Total Amount]
IMPORTANT
Purchase Order Number must appear on all shipping documents.
Please notify us immediately if you are unable to ship by the date specified.
Please include a copy of your invoice with shipment.
Please ship to the address specified.
[Signature]
[Authorized Signature]
CRITICAL](https://pisces.bbystatic.com/image2/BestBuy_US/images/products/edb4c6cb-064f-48a2-b262-7695a53376e1.jpg;maxHeight=427;maxWidth=640?format=webp)
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